Safety and efficacy of antiplatelet therapy with tirofiban after intravenous thrombolysis in patients with disability-causing minor stroke

Abstract:

Objective：To analyze the safety and efficacy of early intravenous antiplatelet therapy with tirofiban after intravenous thrombolysis with alteplase in patients with disability-causing acute ischemic minor stroke. Methods：Clinical data were successively collected using multimode image and also retrospectively analyzed regarding 80 minor stroke patients with small vascular lesions or large artery atherosclerosis. These patients with disability-causing acute ischemic minor stroke were admitted to the Department of Neurology at the Third Affiliated Hospital of Army Medical University from January 2011 to June 2018，each case on admission with a National Institutes of Health Stroke Scale（NIHSS） score of ≤5 and an onset time of <4.5 hours. According to whether tirofiban antiplatelet therapy was intravenously used in the early stage after intravenous thrombolysis，these patients were divided into standard treatment group（n=37） and early intravenous tirofiban treatment group（n=43）. The changes in NIHSS score were evaluated at 24 h，48 h，and day 7 of treatment or at discharge. In addition，the rate of deterioration of clinical symptoms（progression and recurrence），incidence rate of intracranial and other hemorrhages，mortality，and modified Rankin scale（mRS） score after 90 days were analyzed. Results：There were no significant differences between these two groups regarding their baseline data，including sex composition，age distribution，history of underlying diseases，NIHSS score before thrombolysis，constituent ratio of offending vessels，blood pressure，blood glucose，blood lipids，and pre-hospital use of antiplatelet drugs. The early intravenous tirofiban treatment group had a more reduction in NIHSS score than the standard treatment group，but there were no significant differences in NIHSS score between these two groups at 24 hours（NIHSS=2 vs. NIHSS=2，P=0.519），48 hours（NIHSS=2 vs. NIHSS=2，P=0.265），and day 7（NIHSS=3 vs. NIHSS=3，P=0.162） of treatment. The early intravenous tirofiban treatment group had a significantly lower rate of deterioration of clinical symptoms compared with the standard treatment group（4.7% vs. 18.9%，P<0.05）. The incidence rate of hemorrhages and mortality in both groups were 0. There were also no significant differences between the two groups regarding mRS score after 90 days（P>0.05）. Conclusion：It is safe and possibly more effective to perform early intravenous antiplatelet therapy with tirofiban after intravenous thrombolysis for disablity-causing acute ischemic minor strok.